BAC - Chapter 3: Airway Mx in Anaesthesia

Question 1

What is the aim of the airway assessment in terms of answering 3 airway questions?

Answer 1

1. Difficult mask ventilation?
2. Difficult laryngoscopy?
3. Difficult rescue airway?

Question 2

NB on airway Hx: (MNO)

Answer 2

M - Medical Hx: apnoea/ pregnancy/ RA
N - Notes: prev anaesthetic notes or records/ size or length ETT
O - Old tracheostomy

Question 3

Assessing difficulty with mask ventilation: (BONES)

Answer 3

B - Beard
O - Obesity 
N - No teeth
E - Elderly
S - Snoring

Question 4

Assessing difficulty with laryngoscopy: (4Ds)

Answer 4

1. Disproportion - macroglossia, micrognathia, short fat neck, high arched palate
2. Distortion - congenital, traumatic, tumour
3. Dysmobility - limited mouth opening, cervical spine disease
4. Dentition - loose, missing

Question 5

LEMON evaluation:

Answer 5

L - Look externally
E - Evaluate 332 in fingers (3 inter-incisor distance, 3-hyoid mental distance, 2 thyroid to floor of mouth)
M- Mallampati score
O - Obstruction
N - Neck mobility: raise chin above occiput, thyromental distance > 5 cm, sternomental distance > 11.5 cm

Question 6

Assessing difficulty with rescue airway: (RODS)

Answer 6

R - Restricted mouth opening
O - Obstruction of upper airway
D - Distortion/disruption
S - Stiff lungs

Question 7

Mallampati score:

Answer 7

1. Visualise - faucial pillars, SP, uvula
2. Visualise - faucial pillars, SP
3. Visualise - SP
4. Can’t visualise SP

Question 8

Cormack Lehane grading of laryngoscopy:

Answer 8

1. Full view of glottis
2. Partial view of glottis
3. Only epiglottis visible
4. Neither glottis or epiglottis visible

Question 9

Options in anaesthesia w.r.t airway Mx:

Answer 9

1. Maintains own airway
2. Assisted airway
3. SGA - Guedel, LMA, iGel
4. Transglottic airway - ETT
5. Surgical airway - needle cricothyroidotomy, tracheostomy

Question 10

How to position head for intubation?

Answer 10

1. Neck flexed
2. Head extended
3. Sniffing position

Question 11

How to confirm placement of ETT?

Answer 11

1. Visualise tube passing through cords
2. Symmetrical chest rise
3. Misting of tube
4. Capnography
5. Auscultation - bilateral axilla + stomach

Question 12

RSI order:

Answer 12

1. Assessment
2. Preparation
3. Adjust head/ neck before starting
4. Pre-O2 w/ 100% FiO2 for 3-5 min, end tidal O2 > 80%
5. Pre-calculate induction drug + mm. relaxant
6. Cricoid pressure
7. Give drugs
8. Intubate
9. Confirm placement

Question 13

What to do when failed intubation?

Answer 13

1. Call for help
2. Plan B: Maintain O2 with SAD - max 3 attempts
3. Plan C: Facemask ventilation - successful - wake up patient
4. Plan D: Emergency surgical airway